Doctors Finally Told to Take IUD Pain More Seriously
/By Crystal Lindell
The American College of Obstetricians and Gynecologists (ACOG) is finally acknowledging just how painful some uterine and cervical procedures can be for women.
They are now recommending pain treatment for in-office procedures that patients have long complained were under-addressed.
The ACOG’s new guidelines address pain from intrauterine device (IUD) insertion, endometrial biopsy, hysteroscopy, intrauterine imaging, cervical biopsy, and other similar procedures.
“There is an urgent need for health care professionals to have a better understanding of pain-management options and to not underestimate the pain experienced by patients and for patients to have more autonomy over pain-control options during in-office procedures,’ the ACOG said.
While the recommendations vary by procedure, most of them involve some version of lidocaine, and a few recommend NSAIDs and naproxen. For more intense procedures and conditions like hysteroscopy, ablation, and polypectomy, they recommend local anesthesia.
For IUD insertion, a procedure that patients have long complained was extremely painful, the ACOG recommends local anesthetic agents. More specifically, they recommend applying lidocaine cream, lidocaine spray, or a paracervical lidocaine block injection.
The ACOG says pain management options “should be discussed with and offered to all patients seeking in-office gynecologic procedures."
However, there is a telling couple of sentences in the new guidelines that reveal how doctor-centered the thought processes around pain management still are.
The ACOG acknowledges that some healthcare professionals tend to underestimate the pain that patients experience and that pain management “may not be discussed with or offered to patients.” Basically, some doctors don’t believe that patients experience pain, so they don’t even bother to offer pain treatment options.
There may also be a false belief that a pain treatment that works for one patient must work for everyone.
“Several pain-management interventions being used have limited or conflicting evidence supporting their effectiveness at providing adequate pain control during in-office gynecologic procedures,” the ACOG said.
“Health care professionals therefore must be cautious when extrapolating data on what works for one procedure to another. Shared decision making with the patient should be practiced when discussing pain-management options because options that work for one patient may not work for another.”
It’s good they are acknowledging the issue. I always say that other people’s pain is always easier to endure. Of course doctors think pain management is unnecessary – they aren’t the ones in pain!
The ACOG adds that “despite patients reporting a higher level of pain than clinicians expect, patients still report a high level of satisfaction with office procedures.”
It’s so telling that they think that patient satisfaction scores should even be mentioned when deciding pain treatment guidance. As usual, there tends to be a focus on how patient pain impacts the doctor and their practice. And it’s even more telling that they think they don’t need to treat pain as long as patients don’t complain.
In reality, doctors should be treating pain because pain sucks, and it’s the right thing to do!
I am glad to finally see more official guidance for doctors to treat pain that patients have long reported. But if doctors would just believe their patients when they report pain, they wouldn’t need the ACOG to tell them to treat it.
